Provider Demographics
NPI:1043360464
Name:LOS ANGELES HOME HEALTH CARE AGENCY, INC.
Entity Type:Organization
Organization Name:LOS ANGELES HOME HEALTH CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAMERIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-559-2290
Mailing Address - Street 1:2741 S ROBERTSON BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2403
Mailing Address - Country:US
Mailing Address - Phone:310-559-2290
Mailing Address - Fax:
Practice Address - Street 1:2741 S ROBERTSON BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2403
Practice Address - Country:US
Practice Address - Phone:310-559-2290
Practice Address - Fax:310-559-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08161FMedicaid
CAHHA08161FMedicaid